Anxiety

Question 1

Describe how anxiety varies between individuals.

Answer 1

Anxiety is on a spectrum

It is a disorder when it impairs functioning or is distressing.

Question 2

Describe normal fear/anxiety.

Answer 2

Response to objectively dangerous/life threatening situations.
Protects from harm, constructive action

Question 3

What are the domains of anxiety?

Answer 3

Physiological
Cognitive
Affective
Behavioural

Question 4

Describe the physiological domain.

Answer 4

Physiological response - what the body does when in fear (e.g. fight/flight response)

Question 5

Describe the cognitive domain of anxiety.

Answer 5

Perception of danger, threat, loss (thoughts in moment of initial fear)
Changes in cognition - sharp/clear or confused/foggy

Question 6

Explain the affective domain of anxiety.

Answer 6

What we feel - nervous, fear/scared, anxious, uneasy, terror/dread

Question 7

What is the behavioural domain of anxiety?

Answer 7

What we do - fight/flight/avoid/safety behaviours

Question 8

What is abnormal anxiety?

Answer 8

Degree of fear or anxiety is greatly disproportionate to the risk or severity of possible danger.
Inaccurate appraisal of threat to wellbeing.

Question 9

What causes abnormal anxiety?

Answer 9

Overestimating the danger

Overestimate the probabilty

Question 10

How long does abnormal anxiety occur?

Answer 10

Occurs or continues to occur even though no objective danger exists. Anticipation of future threat.

Question 11

List the anxiety disorders we will study.

Answer 11

Panic Disorder
Agoraphobia 
Specific Phobia 
Separation Anxiety 
Social Phobia 
Generalized Anxiety Disorder

Question 12

What are anxiety related disorders?

Answer 12

OCD, PTSD, Acute stress disorder

Question 13

Define a panic attack (remember this is a CRITERIA for PANIC DISORDER)

Answer 13

Intense abrupt surge of fear that includes 4 or more of the following symptoms & peaks within 10 minutes:

• Palpitations, pounding heart, accelerated HR
• Sweating
• Trembling or shaking
• Shortness of breath/smothering
• Feelings of choking
• Chest pain/discomfort
• Nausea/abdominal distress
• Dizzy, unsteady, lightheaded, faint
• Chills or heat sensations
• Numbness or tingling sensations
• Derealization or depersonalization
• Fear of losing control/going crazy
• Fear of dying

Question 14

Describe the criteria needed to diagnose Panic Disorder.

Answer 14

A - recurrent unexpected panic attacks
B - at least one of the attacks has been followed by 1 month (or more) of one or both of the following:
1 - persistent concern or worry about having additional attacks or their consequences (heart attack, going crazy)
2 - significant maladaptive change in behaviour related to the attacks

Question 15

What is the prevalence and median age for Panic Disorder?

Answer 15

Lifetime prevalence: 4.7%

Median age: 20-24 years

Question 16

Things to note about Panic Disorder

Answer 16

Panic attack - full symptoms vs limited symptoms attacks
May be expected or unexpected
Criteria is recurrent (more than one) panic attacks
Frequently comorbidity = with agoraphobia

Question 17

What conditions and substances produce panic like symptoms?

Answer 17

Anameia, angina, COPD, epilepsy, parathyroid disorders
Marijuana, caffeine, general anesthetics
Withdrawal from substance use

Question 18

List the criteria of Agoraphobia.

Answer 18

A - Marked fear/anxiety about two or more of the following
1 - using public transport
2 - being in open spaces
3 - being in enclosed spaces
4 - standing in line/being in a crowd
5 - being outside of home alone
B - Individual fears/avoids these situations due to concerns not able to escape or help not available or embarrassing symptoms
C - almost always provoke fear/anxiety
D - avoided/need a companion/endured with intense fear
E - out of proportion to the actual danger posed
F - persistent (typically 6 months or more)
Causes significant distress or impairment in functioning

Question 19

What is the lifetime prevalence of agoraphobia?

Answer 19

1.4%

Question 20

Describe the symptoms of Specific Phobia.

Answer 20

Marked fear/anxiety about a specific object or situation.
Almost always provokes fear/anxiety.
Avoided/endured with intense anxiety.
Fear is recognized as excessive/unavoidable.
Persistent, (6 months or more)
Avoidance, fear or anxiety significant distress impairs functioning.

Question 21

What is the lifetime prevalence of specific phobia?

Answer 21

7.2% - 11.3%

Question 22

What are some key clues for children suffering from Specific Phobia?

Answer 22

May not always identify physiology or thoughts
Avoidance often key identifier
Somatic symptoms (feel sick, sore tummy)
Crying, tantrums, clinging

Question 23

Describe the criteria for Separation Anxiety Disorder.

Answer 23

Developmentally inappropriate & excessive fear concerning separation from those to whom the individual is attached, 3 or more of the following:
1 - recurrent excessive distress when anticipating or experiencing separation from home/attachment figures
2 - persistent/excessive worry about losing attachment figure or possible harm to them
3 - persistent worry about an event that causes separation
4 - reluctance or refusal to go out due to fear of separation
5 - reluctance to be alone or without attachment figures in home or other settings
6 - reluctance or refusal to sleep away from home or without the attachment person there
7 - nightmares involving separation
8 - physical symptoms when separated (headaches, stomach ache, nausea, vomiting)
Persistent (4 weeks for child/adolescent, 6 months for adult)
Causes significant distress or impairment in functioning

Question 24

What are the symptoms of the domains associated with separation anxiety?

Answer 24

Physiological - breathless, sore tummy, nausea, sick
Cognitive - I can’t, vivid nightmares about separation
Affective - nervous
Behaviour - avoidant, refusing to be separated, crying, clinging

Question 25

Name some typical presentations of separation anxiety.

Answer 25

``` Avoidance of school/going to friend's houses/staying away from home Somatic symptoms Extreme reaction to forced separation Middle childhood most common (6-9yrs) Check for other factors (bullying etc.) ```

Question 26

Describe the criteria for Social Phobia.

Answer 26

Marked fear or anxiety about one or more social situations in which individual is exposed to possible scrutiny of others. Fears that he/she will act in a way to show anxiety symptoms that will be negatively evaluated. Social situations almost always provoke fear/anxiety. Avoided/endured with intense anxiety Fear is excessive/unreasonable Persistent (6 months or more) Avoidance, fear or anxiety significant distress or impairs functioning.

Question 27

What is the paradox of Social Anxiety?

Answer 27

The actual fear of being nervous, inhibited, looking anxious = reasonable probability of being recognized. Overestimates the threat = hypervigilant to cues from others about their acceptability.

Question 28

What is the prevalence and normal age of social phobia?

Answer 28

Lifetime prevalence 3% -13% | Develops in late childhood and adolescence

Question 29

Describe the criteria of Generalized Anxiety Disorder (GAD).

Answer 29

Excessive anxiety or worry occurring more days than not for at least 6 months about a number of events or activities. Individual finds it difficult to control the worry. 3 or more of the following: - on edge, restless, keyed up - easily fatigued - can't concentrate/mind going blank - irritability - muscle tension - sleep disturbance Anxiety or worry causes clinically significant distress or impairment.

Question 30

What features in life are common causes for GAD?

Answer 30

``` School/work performance Finances Family/relationships Health Community/world affairs Minor matters ```

Question 31

How does GAD differ from non-pathological worry?

Answer 31

Excessive vs not excessive More pervasive, distressing & longer duration vs perceived as manageable Frequently without a precipitant vs can be put off when more pressing matters arise Impairs functioning vs less likely to be accompanied by physical symptoms

Question 32

Describe the two different types of GAD.

Answer 32

Type 1 worry (positive elements) = worries about external events Type 2 worry - worry about the worry (negative) = my worry is uncontrollable, I could go crazy with worrying, my worries will take over and control me